Bipolar Disorder

Bipolar Disorder

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Posts: 4

Sep 9 07 9:38 AM

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I have been diagnosed with and rated in the past for Anxiety and Depression, but my new doctor has diagnosed me with Bipolar Disorder. Do I resubmit a new claim to the VA through my VSO or do I leave things as they are?

The others are correct, you cannot have two MH conditions, however, bipolar does hold it's own code as compared to depression.

You can file a claim showing that the bipolar is a result of a worsening of the depression. Which is very possible. Bipolar has an additional set of symptoms than depression does and can result from being on the anti-depressants.

If you were treated for depression while in the service it is very possible you actually should have been treated for bipolar, but they only treated the depression because that's all they saw. This is what happened to me. But upon detailed review of my medical history by a good Dr at my last C&P it was determined that I was up and down like a yoyo. It's just that the only time I either sought help or was sent for help was when I was deeply depressed.

I would leave the claims portion alone. Why muddy the waters when there is nothing to gain and possibly something to lose by doing so. If you file for Bi-polar the VA may see that it is the bi-polar to be the cause of your problems and not depression.

A lot of the same problems for bipolar are the same for depression and is the same for bipolar and is the same.....etc.

Again, I wouldnt muddy the waters with the VA. However, please make sure that you do get the right treatment for your MH conditions.

brianwl,
Your comment left me a bit confused (not an uncommon state for me). My final p/t rating decision has two distinct mental health diagnosis (conditions), with two distinct VA related coding numbers (code numbers did not appear on the final decision papers or at least I cant recall, if they did) . I found this out when I moved to another state, and the VA hospital intake clerk entered the wrong final decision code numbers and added their respective percents (adding up to 100 Percent). The new and incorrect diagnosis and codes were quite unflattering and appeared on my newly added hospital records. It may have been some doctor's opinion, and there are lots of them !@#&^*!, but not what I was rated for.
They also added the percent of all my other diagnosis, that were not on my final p/t rating decision, but were my correct service connected conditions (physical health related) and they still had the old percents attached to them, and did not appear to directly figure into the final rating decision (it seemed to proper to include them on my records). As we all know, you can not be more than 100 percent, even though the total percents of all my diagnosis (with their own separate diagnostic VA code numbers) arrives at 150 percent. The VA's numbers given to me did not look like CPT codes.
The VA 1-800 folks said that I needed to have the person at the hospital, who entered the wrong numbers, make the correction and they provided me with the correct numbers to give to them.
Two separate , and distinct mental health diagnosis (conditions), with two separate and distinct VA numbers that added up to 100 percent, on my final rating decision papers. Each condition could stand alone as a distinct diagnostic condition. Oh well....?
fourmanhd

p.s. I wasn't even aware that the VA assigned a particular type of number to each diagnosis. I, sort of thought that, maybe, the numbers might be relate to a DSM iV classification, but as I have indicated, I was just trying to not be seen as having an official condition that was not on my VA decision paperwork. The VA may consider them as only one and total 100 percent condition, but there are sure two distinct and medically separate DSM IV classifications, i.e. diagnostic conditions on my final rating and the VA service officer gave me two numbers to correct the situation. I certainly am very far from an authority on the subject; I'm just stumbling around in the system....
I Think I Am,
fourmanhd

It is not uncommon for one person to have more than one mental health diagnosis. In an area that is this subjective not all doctors will agree on a single diagnosis, in some cases the person actually has more than one condition, and it also isn't uncommon for a diagnosis to change as a condition goes along.

The point is that since all mental health conditions are evaluated on the basis of the exact same criteria there can only be one disability evaluation, no matter how many diagnoses you have and no matter how many of them are service connected.

It also isn't possible in most cases to separate out a symptom and say it is from one diagnosed condition and not another because most mental health conditions share the same symptoms. For this reason if you are service connected for a mental health condition ALL of your mental health symptoms will be attributed to that condition even if you have another mental health condition that is not service connected. As a Rating Specialist I never really paid any attention to the diagnosis after service connection was granted. I just looked at the symptoms.

Having said that, I am aware that there have been a few situations arise where a Rating Specialist has attempted to do just the opposite of what I am saying by associating a symptom with one mental health disorder and not another, although I suspect that this is very rare. I also suspect that any attempt to do this would not prevail on an appeal.

Curiser,
I agree with your professional perspective and the nature of your good work. From a medical standpoint, however, symptoms drive only a portion of the therapeutic approach and treatment goals; there are scores of reasons why both diagnosis and treatment approaches evolve. Granted, mental health treatment can be very subjective and subject to varied professional medical opinion, but medical treatment teams are very skilled and well trained. Symptoms may only revel the circumstances of the current medical approach and/or the patient's psychosocial situation, and not their underlying pathology. Symptoms are generally an outward "snapshot" in time. Any patient who has run the gauntlet of years of hit-and-miss medication trials that have altered their behavior negatively or has had no appreciable effect, or has been totally discouraged by marginal behavioral approaches, may understand the frustration of mental health treatment.

It can be a very positive experience, once the combination of medication and therapeutic modalities can end up relieving the symptoms of their underlying pathology(s). Mental health issues can find their causes in the realm of physiologically distinct disorders, not unlike MS being incorrectly treated for years before an astute doctor correctly diagnoses it and sets off on medically appropriate treatment. Almost every major change in therapeutic and medical treatment, with its drug alterations, requires a diagnostic justification. It is not just the "symptom of the day", it is finding a multilevel treatment approach that works; for some people with mental health issues this can happen in a reasonable time, for others; it seems to go on forever.
But, I digress, I was only looking to fix a clerical error, these things happen from time to time.
fourmanhd

p.s. it takes me forever to slap two word together, my mind isn't what it used to be...

Quote:From a medical standpoint, however, symptoms drive only a portion of the therapeutic approach and treatment goals

My comments are limited to how VA assigns a disability evaluation to a mental disorder, nothing more. How the mental health professionals arrive at a diagnosis or how they treat a mental health disorder is not something that the Rating Specialist really needs to be concerned about beyond having a basic understanding of what they are saying.

For evaluation purposes the mental health professional describes the symptoms and functional impairment that are present and based on that description the Rating Specialist assigns an evaluation. Like I said, once service connection is granted for a mental disorder, almost any mental disorder, most Rating Specialists don't even bother to look at the diagnosis anymore because it doesn't matter what it is, they are all evaluated exactly the same.

They just concentrate on the description of the functional impairment because for all practical purposes the diagnosis, or the treatment plan, means little. That isn't their function.

I speak only for me as a disabled veteran; it appears as if I live in two worlds, and both can be filled with confusion and occasional disheartenment. One world that sets the rules on how or if I am qualified for many and varied benefits offered by the VA administratively and another world of getting the appropriate and skilled medical care that is well offered by the VA's medical professionals.
It is tough and confusing, at times, to navigate in either. In my position, I appreciate, and am thankful to receive assistance and clarification in both worlds, on this site.
For me, the worlds are not clearly black and white, and sometimes it is hard to know where to start or where to go. But, I do know that there are many mental health issues facing veterans, and that they (I) can use all the advocacy and assistance they (I) can compassionately receive. Again, I am always grateful for the support that this site grants.
fourmanhd

I have applied for S/C aggravation for bipolar disorder in 2003. About 2 years ago I received a denial becuase the VA said the well documented symtoms that I
had while in service were acute and transitory, not permanent aggravation. About 3 months ago I obtained an IMO from my psychiatrist explaining the symptoms I
experienced were permanent aggravation since I seeked treatment on two occasions for depression and mania. I haven't heard anything from the VA and now
I'm wondering if I should get another IMO favorable to permanent aggravation. Do you think one IMO will be enough or do you think I need to get another
favorable opinion?????

First of all it appears from your writing that you have filed a claim 3 months ago? Just because you haven't heard from the VA doesn't mean anything
(good or bad). It is just a slooooooooooooooow process.

Not an expert on this...but how strong do you feel your IMO letter is in addressing the reason for the VA denial? Is it spot on? Have you
had a VSO look at it and what is his/her opinion?

If the above is thumbs up then you just need to wait. Waiting stinks. Somedays I feel my claim is a slam dunk and other days I think the VA will just deny
it.

Here's what happened to me. I don't know if your situation is the same or not. While I was in the service I was treated on and off (mostly off) for my
entire career for one Mental Health Disorder or another. The main reason for the "off" periods is that I was both in denial to myself and trying to
keep my condition from being known to the AF because I didn't want to lose either my security clearance or while I was flying, my flying status.

As it turned out, I ended up losing the flying status due to my MH issues anyway.

Long story short, my keeping the AF in the dark burned me when it came to getting the rating I deserved from the VA. I just didn't have the track record in
my medical records. This is where I think your "transitory" issue is biting you in the +%#. It sounds like you are facing the same dilema.

I was initially rated by the VA in 93 for MDD based on my condition at the time. I was a complete mess and literally broke down during the examination. After 7
years of treatment for that condition my VA Psychiatrist determined that I was in fact Bipolar, not just MDD. He changed my meds accordingly. After another 4
years of drug therapy (not counseling), my Bipolar got to the point it couldn't be conotrolled and I could not longer function in any job. I had tried many
(10) different jobs from 93 to 2004 and just couldn't handle it. I was argumentative with both my bosses and coworkers.

Finally in 05 I was turned down for VRE and told to apply for IU and SSDI. I did that and in Sep 07 was granted IU with P&T.

Ok, not that I've told you my story. Here's the point. You need to get the VARO to understand that your "transitory" episodes in the military
were in fact you trying to hide your condition, if in fact that is the case. Remember, the thing about Bipolar is its a sneaky disease. You don't go for
help unless you are depressed and if your Bipolar is anything like mine, you were more manic than depressed. Consequently you figured you could handle it and
actually thought you were ok and everyone else was wrong.

It's taken me about 30 years to finally understand my condition and how it affects my life and how to survive with it.

Hi and thank you for your information. I did let the VA know I didn't seek treatment from the Navy out of fear of losing my top secret clearance that was
required to be a CTO. This was also clearly stated in the IMO from my shrink. I did have many manic episodes but yes it was when I was deeply depressed that I
seeked outside help. All of this was in my IMO and the IMO was 3 pages long and detailed. I just hope the VA doesn't come back with another denial saying
my symptoms were "acute and transitory."

Thank you for your reply. I filed my appeal right after I received the denial letter. This was about 2 1/2 years ago. The IMO was very detailed and countered
everything on the denial. I even gave a copy of the denial letter to my shrink and he was disgusted with it and said to me my symptoms documented in the navy
were definetely not acute and transitory. It was a detailed 3 page IMO that he constructed for me.

"The claim for service connection of "depression" will be considered along with your appeal regarding service connection for bipolar
depression (i.e. bipolar disorder) because the two conditions are inextricably intertwined and represent an identity of issues and evidence."

What does this actually mean and is this a positive for my claim since they said they used the word considering?

For having multiple mental disorders, it can become the chicken vs the egg syndrome. It cases where there are two or more mental disorders, you look at Axis I
and see which one is listed first. Each subsequent disorder listed after the first one are secondary conditions that are in some form or fashion related to the
primary one. since Bipolar Disorder is a an affective disorder like Major Depression, Dysthymia, etc., one can say that if you have Major Depression with
Bipolar, then the practitioner would develop a severity level based on the primary diagnosis.

A person may have been originally diagnosed with moderate MD and later found to have Bipolar Disorder which may cause the Major Depression to become severe. So
in terms of claims the nexus between the two might boost your initial mental health rating to a higher SC%. Like from 50% to 70%.

Whole:

The VA is saying because both conditions come from the same etiology that it may be in some wy influencing your original SC condition. Cruiser may be able to
explain the trappings of the VA, I can only speak to it from a practitioner's point of view.

wholesalecd wrote:
What does this actually mean and is this a positive for my claim since they said they used the word considering?

For evaluation purposes VA cannot separate these two conditions. If service connection is established for one of them, any symptoms associated
with the other one, even if it isn't specifically service connected, will be attributed to the service connected condition for purposes of evaluating that
condition. Basically, if you are service connected for one mental disorder, for evaluation purposes you are service connected for almost all mental disorders.